Emotional Health, Obesity, and Time to Pregnancy Suzanne Tough PhD1,2, Jodi Siever MSc3, Monica Jack3

1Department of Paediatrics, University of Calgary, 2Department of Community Health Sciences, University of Calgary, 3Public Health Innovation and Decision Support, Alberta Health Services

Participants 1,044 urban women who had recently delivered

their first live-born infant

Data Collection A computer-assisted telephone interview

Primary Outcome self-reported time to pregnancy

Other Data socio-demographic characteristics self-esteem (Rosenberg Self-Esteem Scale) lifestyle factors medical and reproductive history factors considered before having children knowledge of factors related to reproduction self-reported emotional and physical health

Background

Women Included in Analysis

Bivariate Comparisons by Time to Pregnancy

Objective

Methods

Excluded from analysis

469 women

Completed the survey

1044 women

(72% of eligible women)

Included in analysis• Planning to get pregnant• Not using contraception• <35 years at the start of

trying to conceive

575 women

High body mass index, poor emotional health and a history of pregnancy complications independently delayed conception for women under 35 with no previous live-born births.

Women with good emotional health may become pregnant more quickly, or it may be that emotional health deteriorates as couples do not conceive within 6 months.

Public health strategies could highlight the influence of a healthy body weight and positive emotional health as factors that may influence time to pregnancy among women under 35, which may reduce the need for assistance to reproduction.

Conclusions

Cumulative Probability Distribution of Time to Pregnancy

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0 6 12 18 24 30 36 42 48 54 60 66 72 78 84 90 96 102 108 114 120Time to pregnancy (months)

Characteristic≤6

monthsN=351

>6 monthsN=224

OverallN=575

p-value

Well-Being & Lifestyle

Overweight/Obese pre-pregnancy BMI

24% 34% 28% 0.009

Poor/fair emotional health 6 months prior to pregnancy

5% 17% 10% <0.001

Drinking Behaviour 0.011

Non-drinker 52% 63% 56%

Drinker 38% 33% 36%

Binge drinker 10% 4% 8%

Events in Past 2 Years that Influenced Timing of This Pregnancy

Emotional health conditions 15% 25% 19% 0.005

Life events 26% 11% 20% <0.001

Personal goals 23% 11% 18% <0.001

Corporate/work goals 26% 15% 22% <0.001

Previous Pregnancies

First time pregnant 88% 77% 83% 0.001

History of pregnancy complications, abortion or miscarriage

11% 21% 15% 0.001

Past pregnancy problems made you afraid to get pregnant again

19% 44% 33% 0.009

Fertility Methods

Any prescription medication 1% 38% 15% <0.001

Artificial insemination 0% 38% 15% <0.001

In vitro fertilization (IVF) 0% 15% 6% <0.001

Intracytoplasmic sperm injection (ICSI)

0% 16% 6% <0.001

To determine factors related to becoming pregnant within six months of trying

To determine the relative impact of body mass index and emotional health on time to pregnancy

Among all women*

N=568

Hazard Ratio

(95% CI)

Among women who were not using any fertility

medications or treatments

N=480

Hazard Ratio

(95% CI)

Overweight/Obese pre-pregnancy BMI 1.34 (1.05, 1.72) 1.31 (1.02, 1.68)

History of pregnancy complications, history of miscarriage, history of abortion

1.42 (1.02, 1.99) 1.63 (1.17, 2.29)

Fair/poor self-rated emotional health at 6 months prior to pregnancy

2.02 (1.27, 3.22) 1.72 (1.08, 2.75)

Multivariate Proportional Hazards Model of Factors Determining Time to Pregnancy Greater Than 6 Months

* Among women planning to get pregnant, not using contraception, and under the age of 35 when they started trying to get pregnant

CharacteristicOverallN=575

>$40,000 Household Income 88%

Caucasian 85%

Education

Less than high school 2%

High school 23%

Post-secondary 64%

Post-graduate 10%

Married/common-law 99%

Working in 6 months before pregnancy

93%

Sociodemographic Characteristics

Understanding the factors that influence time to pregnancy can assist in preconception planning and inform interventions